Dry Sockets: What causes dry sockets?

Some studies have suggested that people who smoke are more than four times more likely to experience a dry socket than a nonsmoker. A number of theories have been postulated as to what the association between tobacco smoking and dry sockets might be. Some relate it at the cellular level and the cytotoxicity of the smoke itself while others to the overall systemic effects of nicotine. The carbon monoxide that is introduced into the bloodstream by smoking does reduce the amount of oxygen that can be carried, thus producing a reduced oxygenation of the healing tissues. Additionally, it has been theorized that tobacco smoke might contaminate the wound site or may alter its bacterial population. One other factor to consider, the sucking action associated with smoking may draw out or otherwise dislodge the blood clot that has formed in the tooth socket.

Women who take oral contraceptives are at greater risk for dry sockets.

Women who take oral contraceptives (birth control pills) seem to be at greater risk for developing dry sockets than those who don't. It is thought that estrogen can play a role in disintegration of the socket's blood clot. It has been suggested that by coinciding their tooth extractions with those days in their oral contraceptive dosing cycle when their medication contains its lowest estrogen levels may help to minimize the occurence of dry sockets. The association between estrogen and dry sockets in general may also explain why women as a group are 20% more likely to experience dry sockets than men.

The presence of bacteria may play a role in dry socket formation.

There is some research that supports a view that bacteria might play a role in the development of dry sockets. Some studies have reported that dental patients who have a high pre or postoperative bacterial count in the region of the extraction site are at greater risk for dry socket formation. People who have poor oral hygiene seem to have a greater incidence experiencing dry sockets. People who have active infection in the gum tissue surrounding a tooth (pericoronitis) are also at greater risk.

This is one reason why a dentist might feel that they need to place a patient on a regimen of antibiotics for some days before an extraction is performed. This is also the reason why some studies have suggested that rinsing with an antibacterial mouthwash (chlorhexidine) before a tooth extraction or placing an antibiotic-impregnated packing into the tooth socket at the time of the extraction can be ways of minimizing the occurrence of dry sockets. These findings are not universally accepted by the dental community however and therefore are not universally practiced. While it would always be left up to the discretion of the treating dentist, most protocols for treating dry sockets do not include placing the dental patient on an antibiotic regimen.

The age of the dental patient may be related to the risk for experiencing dry sockets.

Some studies have suggested that there is an association between the age of the dental patient and the incidence of dry socket formation. While not supported by the findings of all studies, the general rule of thumb is that comparatively younger patients are at less risk for dry sockets than comparative older patients. As an example, one study found that dental patients in the age group 15 to 19 years developed dry sockets at a rate of about 3% whereas patients in the age group 30 to 34 experienced them at three times this rate. This is one of the reasons why a dentist might suggest wisdom tooth removal in the age window: late teens to early 20's.

Dry socket risk: Location, location, location.

The location of the tooth needing extraction seems to correlate with the risk of dry socket formation. In general there is a greater incidence of dry sockets with the extraction of lower teeth as opposed to upper teeth. A greater incidence of dry sockets with molars as opposed to front teeth. The greatest risk of dry socket formation seems to be associated with lower wisdom teeth, especially impacted lower wisdom teeth.